Provider Demographics
NPI:1720346406
Name:BUCKLEY, MICHAEL TIMOTHY (CASAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 39TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2909
Mailing Address - Country:US
Mailing Address - Phone:718-871-7433
Mailing Address - Fax:718-871-7419
Practice Address - Street 1:449 39TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2909
Practice Address - Country:US
Practice Address - Phone:718-871-7433
Practice Address - Fax:718-871-7419
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC 17580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)